The goal of this project is to create a community model of care delivery and patient safety using ISO 9001 principles as a framework of cooperation. This is a horizontal model of integration that involves establishing an anticoagulation clinic, which will employ evidence-based practice guidelines to improve the safety and management of patients on warfarin therapy. The overall aim be accomplished by utilizing an ISO 9001 quality management system framework for coordinated care management, support by quality tools and training, informed by evidence-based practices, and sustained long-term through evaluation of a new payer-supported fee structure. The project specifically addresses the National Quality Forum safe practices: 1. Creation of a [unreadable] healthcare culture of safety; and 2. utilization of dedicated anti-thrombotic services that facilitate [unreadable] coordinated care management. The unique feature of the research will be the utilization of ISO [unreadable] 9001 quality management system principles to design a term of care that will establish and operate the clinic. We will study whether the utilization of these ISO principles, such as auditing and a common document control system, will serve as a framework to enable cooperation between two competing hospitals and numerous providers. Rockwell Collins, a major employer in our community, will assist in the project. Rockwell engineers will utilize their avionics systems building expertise to design mistake-proof features to ensure patient safety and minimize errors. Wellmark Blue Cross/Blue Shield of Iowa will provide a matching grant and will evaluate cost/outcome data, in order to determine the feasibility of establishing a management fee to provide a means of long-term support for clinic. Cost/outcome data will be analyzed by the Delta Group via established clinical and risk adjustment algorithms. Specific Aims: 1) Education and training in principles of ISO 9001 quality management systems; 2) Establishing the anticoagulation clinic; 3) Determining other uses of ISO 9001 framework within the healthcare community. The project will create a model of patient care and cooperation, addressing the issue of [unreadable] developing care delivery systems in a competitive environment, and it is likely that the model could be implemented in other communities. Specific tools include, but are not limited to: training materials on teaching quality concepts related to ISO 9001, anticoagulation care guidelines, and guidelines related to ISO auditing and document systems. [unreadable] [unreadable]